Private Lesson Intake Form

Private Lesson Intake Form
Owner Information

Lessons & Consultations are provided if you live within 30 minutes of Morrisville, VT.
PLEASE READ

You have 2 choices for lessons and both are held in your home.

You can either book a single 90-minute Private Consultation for $275.00

OR

You can book a series of 3, 1-hour lessons for $525.00
Which
Name

First NameLast Name
Email
example@example.com
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dog Information
Dog's Name
Dog's Age
Dog's Breed or Best Guess
Sex
How long have have you owned your dog?
Where did you get your dog?
Behavior History
What are the main issues you want help with? (Be specific)
When did these behaviors begin?
Have these behaviors gotten better, worse, or stayed the same?
Where do the issues mainly occur?
**IF OTHER, PLEASE DESCRIBE
Have you already tried to fix the issue(s)?
Have you worked with a trainer or behavior professional before?
If yes, please describe who you worked with and what was recommended:
Environment & Lifestyle
Who lives in the home with the dog?
How much daily exercise does your dog currently get?
**IF OTHER, PLEASE EXPLAIN
What kind of equipment do you currently use on walks?
Safety & Severity
Has your dog ever bitten a person? (Nips are bites)
Has your dog ever bitten a dog? (Nips are bites)
Does your dog guard food, toys, space, or people?
**IF YES, PLEASE EXPLAIN
Your Goals
What would a successful outcome look like for you?
Why is now the right time to get help?
Agreement & Expectations
Signature
Date

MonthDayYear
Date
Once Ian reviews your Intake Form, he will contact you.
Should be Empty:

Private Lesson Intake Form

Owner Information

Dog Information

Behavior History

Environment & Lifestyle

Safety & Severity

Your Goals

Agreement & Expectations